Dataset Information

Effect of Preablation Glycemic Control on Outcomes of Atrial Fibrillation Patients With Diabetes Mellitus Following Valvular Surgery Combined With the Cox-Maze IV Procedure.

ABSTRACT:

Background

This study was performed to assess the effect of preablation glycemic control on atrial fibrillation recurrence rates after heart valve surgery concomitant with Cox-Maze IV ablation.

Methods

Twelve-month preablation trends in glycemic control were studied. Recurrence and clinical outcome data were obtained during a mean follow-up period of 36.7 ± 23.3 months postablation.

Results

Higher glycated hemoglobin (HbA1c) at the time of ablation was associated with higher postablation recurrence rates. The cumulative atrial fibrillation recurrence-free survival of patients with HbA1c ≥7.5% at the time of operation at 12, 24, 36 and 48 months was 97.1, 78.3, 54.2, and 36.3%, respectively (P < 0.001), and 100, 84.9, 37.2, and 16.2% for patients who preoperatively had an upward trend in HbA1c, respectively (P < 0.001).

Conclusion

Maintaining a downward trend in HbA1c during the 12-month period before the operation and an HbA1c value < 7.5% at the time of the operation reduced the recurrence of AF among patients who underwent heart valve surgery concomitant with the Cox-Maze IV procedure.

SUBMITTER: Peng Z

PROVIDER: S-EPMC9130630 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Effect of Preablation Glycemic Control on Outcomes of Atrial Fibrillation Patients With Diabetes Mellitus Following Valvular Surgery Combined With the Cox-Maze IV Procedure.

Peng Zhan Z Zhao Rui R Liu Yuhua Y Yang Yunxiao Y Yang Xiubin X Hua Kun K

Frontiers in cardiovascular medicine 20220511

<h4>Background</h4>This study was performed to assess the effect of preablation glycemic control on atrial fibrillation recurrence rates after heart valve surgery concomitant with Cox-Maze IV ablation.<h4>Methods</h4>Twelve-month preablation trends in glycemic control were studied. Recurrence and clinical outcome data were obtained during a mean follow-up period of 36.7 ± 23.3 months postablation.<h4>Results</h4>Higher glycated hemoglobin (HbA1c) at the time of ablation was associated with highe ...[more]

PMID: 35647051

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Project description:Objective: Atrial fibrillation is the most prevalent persistent arrhythmia in patients with hypertrophic obstructive cardiomyopathy. Comparative analyses of the safety and effectiveness of septal myectomy with and without surgical ablation are limited. This study aimed to compare the outcomes of septal myectomy with and without the Cox-maze IV procedure in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation. Methods: Ninety-four patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent septal myectomy were analyzed, we divided it into concomitant Cox maze surgery (Cox-maze group) and no concomitant Cox maze operation (no Cox-maze group). Freedom from atrial fibrillation recurrence and all-cause mortality after surgery were assessed. Results: Freedom from all-cause mortality after septal myectomy at 1, 3, and 5 years was 98.5 ± 1.5% each in the Cox-maze group and 90.8 ± 6.3%, 85.1 ± 8.1%, and 85.1 ± 8.1%, respectively, in the no Cox-maze group. Patients in the no Cox-maze group had lower survival, freedom from atrial fibrillation recurrence off antiarrhythmic drugs, and arrhythmia control rate (including patients with successful antiarrhythmic drug conversion) than those in the Cox-maze group (P = 0.046, P = 0.040, and P = 0.012, respectively). Patients who underwent the Cox-maze IV procedure had lower atrial fibrillation recurrence rate than those who did not (hazard ratio, 0.141; 95% confidence interval, 0.042-0.479; P = 0.002). Post-operative increases in left atrial diameters (hazard ratio, 1.099; 95% confidence interval, 1.024-1.179; P = 0.009) were associated with atrial fibrillation recurrence. Conclusions: The Cox-maze IV procedure combined with septal myectomy improved mid-term survival and reduced mid-term atrial fibrillation recurrence in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation. The concomitant Cox-maze IV procedure was associated with a lower atrial fibrillation recurrence in patients with surgical hypertrophic obstructive cardiomyopathy and atrial fibrillation.

Project description:Objectives To evaluate the efficacy of the Cox-Maze IV procedure (CMP-IV) in combination with valve surgery in patients with both atrial fibrillation (AF) and valvular disease and use machine learning algorithms to identify potential risk factors of AF recurrence. Methods A total of 1,026 patients with AF and valvular disease from two hospitals were included in the study. 555 patients received the CMP-IV procedure in addition to valve surgery and left atrial appendage ligation (CMP-IV group), while 471 patients only received valve surgery and left atrial appendage ligation (Non-CMP-IV group). Kaplan–Meier analysis was used to calculate the sinus rhythm maintenance rate. 58 variables were selected as variables for each group and 10 machine learning models were developed respectively. The performance of the models was evaluated using five-fold cross-validation and metrics including F1 score, accuracy, precision, and recall. The four best-performing models for each group were selected for further analysis, including feature importance evaluation and SHAP analysis. Results The 5-year sinus rhythm maintenance rate in the CMP-IV group was 82.13% (95% CI: 78.51%, 85.93%), while in the Non-CMP-IV group, it was 13.40% (95% CI: 10.44%, 17.20%). The eXtreme Gradient Boosting (XGBoost), LightGBM, Category Boosting (CatBoost) and Random Fores (RF) models performed the best in the CMP-IV group, with area under the curve (AUC) values of 0.768 (95% CI: 0.742, 0.786), 0.766 (95% CI: 0.744, 0.792), 0.762 (95% CI: 0.723, 0.801), and 0.732 (95% CI: 0.701, 0.763), respectively. In the Non-CMP-IV group, the LightGBM, XGBoost, CatBoost and RF models performed the best, with AUC values of 0.738 (95% CI: 0.699, 0.777), 0.732 (95% CI: 0.694, 0.770), 0.724 (95% CI: 0.668, 0.789), and 0.716 (95% CI: 0.656, 0.774), respectively. Analysis of feature importance and SHAP revealed that duration of AF, preoperative left ventricular ejection fraction, postoperative heart rhythm, preoperative neutrophil-lymphocyte ratio, preoperative left atrial diameter and heart rate were significant factors in AF recurrence. Conclusion CMP-IV is effective in treating AF and multiple machine learning models were successfully developed, and several risk factors were identified for AF recurrence, which may aid clinical decision-making and optimize the individual surgical management of AF.

Dataset Information

Effect of Preablation Glycemic Control on Outcomes of Atrial Fibrillation Patients With Diabetes Mellitus Following Valvular Surgery Combined With the Cox-Maze IV Procedure.

Background

Methods

Results

Conclusion

Publications

Effect of Preablation Glycemic Control on Outcomes of Atrial Fibrillation Patients With Diabetes Mellitus Following Valvular Surgery Combined With the Cox-Maze IV Procedure.

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